Every Saturday, an interdisciplinary group of Yale students examines and counsels patients at the student-run HAVEN Free Clinic on Howard Avenue in New Haven. On Sunday morning, October 7, these students will be in New Haven’s Edgewood Park, for the fifth annual ¡ANDA! 5K Run/Walk, HAVEN’s major annual fundraiser. Anda is a Spanish expression that means "to walk" or "to go", and it is often used to mean "Let's go" or "Come on.” Unlike in the past when most ¡ANDA! participants have been affiliated with Yale, the student organizers hope that their patients, along with other community members, will join the event.
To encourage this, the event organizers have initiated a “Couch to 5K” program, to help prepare people to participate who are not currently able to walk or run a 5K. And the students hope the additional enticement of music, games, and food, will attract more people to participate. (Interested in participating? Click here for a link with details and to register.)
Yale medical, public health, physician associate, and nursing students established HAVEN Free Clinic in 2005. Since it opened, all health care services have been provided by students, under the supervision of doctors, nurse practitioners, and physician associates from the Yale community. Last year, the clinic cared for over 650 patients from the community and more than 250 students from across the university were involved as volunteers.
For its first twelve years, HAVEN was based at the Fair Haven Community Health Center, in New Haven’s Fair Haven neighborhood. In 2017, to avoid potentially violating federal regulations requiring strict separation between free clinics and fee-charging clinics, HAVEN moved to the Yale Physicians Building, on the Yale School of Medicine (YSM) campus. Nicholas Wilcox, a fourth-year YSM student who has served as a junior and a senior clinical team member at HAVEN, and now is director of finance and development, explains that while the Fair Haven location was closer to the majority of HAVEN’s client base and had a less “corporate” feel, Howard Avenue “allows them to operate more efficiently and see more patients, and so overall the relocation has been a net positive.” To address the transportation challenges of the new location, HAVEN reimburses patients for bus expenses, provides gas cards for patients who cannot reasonably take a bus, and is experimenting with Ride Health, a ride program for people needing to access medical appointments.
HAVEN Free Clinic is a fitting name for the clinic, given its home city of New Haven. However, HAVEN is also an acronym for health care, advocacy, volunteerism, education, and neighborhood, and the clinic’s student leaders place great value on all of these components. HAVEN has a dual mission. One part is “to serve as a sustainable free clinic that provides uninsured adults in New Haven with primary care, wellness education, and assistance in securing health care.” The second part of the mission is to educate Yale health professional students about primary care and the value of working in health care teams, as well as to gain experience in community health and be exposed to the challenges of managing patient care with limited resources.
Sascha Murillo, who is starting her research year in the MD program at YSM, is the Jones Fellow. This makes her one of the three student executive directors of HAVEN, along with Patrick Liu, a second-year YSM student, and Jennifer Espinoza, a Yale School of Nursing student. Murillo, who has a background and strong interest in advocacy, has an expansive view of HAVEN’s mission. In addition to being committed to ensuring the clinic is able to continue to provide outstanding health care services, she wants to engage HAVEN volunteers in thinking more about why the clinic’s current patients need a free clinic. For example, what are the systematic gaps limiting access to health care and how can HAVEN work to reduce these gaps? She is eager to have HAVEN’s Community Relations and Engagement Committee work more closely with community partners as part of this effort. Murillo wants to focus on primary care and community-based health care after graduating, so her interest in these questions is both immediate and for the longer term.
HAVEN operates on Saturday mornings from 9:00 am – 12:00 pm, and on a typical morning, there are 50 scheduled visits and about 30 walk-in patients. Only about 20 of these visits are medical visits, because HAVEN offers numerous services beyond medical treatment. For example, there are educational opportunities for patients to learn about topics such as understanding their lab results, smoking cessation, and healthy eating habits. Clients also can access social services, with students from Yale School of Public Health, Yale Law School, and Yale College providing information about how to apply for Medicaid and Medicare. Additionally, the clinic’s pharmacy has a robust inventory, labs can be drawn on site, and the clinic has an active referral service for patients needing specialists. Many patients have appointments with at least two different departments when they visit.
According to Wilcox, “most patients have chronic health problems, which can be prevented from developing into anything more serious through either lifestyle changes or medication.” Wilcox has found it “rewarding to have a longitudinal view and to serve the clinic in different capacities over a number of years. I have seen the clinic move locations, grow, and focus on new initiatives. I am excited, in my new role, to ensure our model is financially sustainable, so that it can serve patients well beyond my tenure.”
¡ANDA! plays a significant role in ensuring HAVEN can balance its annual budget of approximately $40,000. Last year the event raised $27,360, which was almost 70% of the annual budget. This year’s organizers are grateful to have over twenty sponsors—many of them local companies—for the event, and more than 30 student organizers, with responsibilities such as amplifying the event through social media, recruiting sponsors, and obtaining the necessary approvals from the city. The organizers emphasize the positive impact of participation on their website, noting, for example, that $25 covers one complete blood test, $165 pays for a comprehensive patient visit, and $439 covers a patient’s care for an entire year.
What makes HAVEN unique is its interdisciplinary model, which is critical to addressing the needs of patients, which are interwoven with economic, social, cultural, and language issues. You need a whole team. It can’t just be MDs.
Sascha Murillo, Yale School of Medicine MD Degree Student, HAVEN Free Clinic Executive Director
While in the past ¡ANDA! was held in Fair Haven, close to where many patients live, the organizers decided to move the event to Edgewood Park to reduces costs; police, for example, are not needed to close roads to traffic. This enables more of the funds raised to go towards HAVEN’s patient needs. Free shuttles will help participants get to the park.
Murillo explains that while many medical schools have student-run clinics, “what makes HAVEN unique is its interdisciplinary model, which is critical to addressing the needs of patients, which are interwoven with economic, social, cultural, and language issues. You need a whole team. It can’t just be MDs.” Typically about 30% of the students volunteering at HAVEN are pursuing an MD or MD/PhD degree. Joining them are students in public health, physician associate, nursing, and law degree programs, as well as undergraduates who are often interested in careers in the medical field and a few graduate students. Beyond expanding the services HAVEN can provide, the interdisciplinary nature of the clinic benefits the ¡ANDA! fundraising efforts: it allows for a playful fundraising rivalry to develop.
Murillo and Wilcox both express pride in attending a school where the students and the school feel strongly about making HAVEN sustainable. Murillo believes “HAVEN reflects a responsibility that the school and students have to an underserved population.” Wilcox, wearing his finance and development hat, emphasized “we continue to see an unmet need in our community and we require support to properly address it.”